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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 214 to 238 of 335. Go back in thread:
Posted by theo on September 19, 2004, at 7:58:15
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 19, 2004, at 7:11:03
Hey Scott,
Have you thought about trying 60mg in the morning versus 30mg BID to see if a stronger initial dose feels any better?
Also, I added a small dose (10mg) Prozac to my 100mg Lamictal and 750mg Keppra mainly because she's (my pdoc) never prescribed it to me and wanted me to try it before Cymbalta.
I'm experiencing the same results from Prozac that I knew I would since I've been on and off of it several times: relief from depression but "zombie like" and drive/motivation (follow through in tasks) worse. Also, nothing for social anxiety because Prozac has zero calming effect like Paxil, which I won't try again because complete sexual dysfuntion including erectile.
With your 31 days on Cymbalta, even though it may be a completely different feeling than the other meds, do you think it could be better than Prozac for the social anxiety and drive/motivation problems? Also, do you have the zombie effect with Cymbalta that many SSRI's can cause, (happy and smiling but not wanting to follow through with anything)?
I went for my yearly physical exam with my regular doc and was discussing with him my current meds and my problems with Prozac. He suggested Cymbalta because he said it can be calming because of something to do with "calming nerve endings" and went way over my head with medical lingo on his explaination.
My pdoc appointment is this Thursday 9/23/04 and any input would be appreciated.
Posted by Minnie-Haha on September 19, 2004, at 9:09:23
In reply to Re: Cymbalta-PTSD/depression » sunshine211, posted by Paul_d_234 on September 18, 2004, at 11:33:08
> I have depression and anxiety. When my depression is under control I have no anxiety and vis versus.
Sounds just like me (plus insomnia, which is worse when anxiety is up, of course).
Are you one of the ones here trying Cymbalta? If not, what are you taking? And in either case, what's working?
Posted by SLS on September 19, 2004, at 9:30:48
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by theo on September 19, 2004, at 7:58:15
Hi Theo.
> Have you thought about trying 60mg in the morning versus 30mg BID to see if a stronger initial dose feels any better?
That's a good idea. I think I'll give it a try in a few days if I feel I've become stuck.
> Also, I added a small dose (10mg) Prozac to my 100mg Lamictal and 750mg
What happens when you raise the dosage of Lamictal to 200mg?
> Keppra mainly because she's (my pdoc) never prescribed it to me and wanted me to try it before Cymbalta.
My doctor feels that Keppra can actually have a destabilizing effect on some people. I know Dr. Ivan Goldberg is not terribly impressed with it for bipolar disorder. I don't know about how he feels about its use for anxiety, but I don't think he uses it much.
> With your 31 days on Cymbalta, even though it may be a completely different feeling than the other meds, do you think it could be better than Prozac for the social anxiety and drive/motivation problems?
I'm sure you've read that a few people here have noted an immediate decrease in their anxiety, but I don't know if anyone had been suffering from social anxiety specifically. Yes, I do feel that Cymbalta has the potential to be better than Prozac for SA, and might offer advantages to Effexor in that regard.
> Also, do you have the zombie effect with Cymbalta that many SSRI's can cause,
No, and that's one of the advantages I feel Cymbalta would have over Effexor.
> (happy and smiling but not wanting to follow through with anything)?
I am guessing that Cymbalta will produce amotivation in some people. I can't say that I have experienced this yet. One person is reporting it, however. Like other antidepressants, there will be great differences in how each individual reacts to Cymbalta, although I think certain trends are beginning to make themselves visible in the reports offered by the people who are posting. It is just too early to be so definite in predicting how any one person will react to it.
It looks like Cymbalta will be a good drug to treat anxiety disorders as well as depression.
- Scott
Posted by iris2 on September 19, 2004, at 10:00:42
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 19, 2004, at 7:11:03
Scott,
I've been meaning to tell you how great I think it is taht you are giving this a good trial. You have patience. I hope it works out for you. You deserve it.
irene
Posted by iris2 on September 19, 2004, at 10:06:57
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 19, 2004, at 9:30:48
I saw you mentioned this doctors name. I had called his office for an appointment once and left a message. I have had difficulty finding a new pdoc in Pittsburgh. What do you think of going to him as my pdoc? I have not inquired as to the cost yet. Do you have any idea?
irene
Posted by Paul_d_234 on September 19, 2004, at 10:19:15
In reply to Re: Cymbalta-PTSD/depression, posted by Minnie-Haha on September 19, 2004, at 9:09:23
> > I have depression and anxiety. When my depression is under control I have no anxiety and vis versus.
>
> Sounds just like me (plus insomnia, which is worse when anxiety is up, of course).
>
> Are you one of the ones here trying Cymbalta? If not, what are you taking? And in either case, what's working?I'm posting my experience on the Thread here called "Zoloft to Cymbalta". So far so good on Cymbalta but it is only 5 days - remains to be seen but so far so good.
>
Posted by theo on September 19, 2004, at 10:21:30
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 19, 2004, at 9:30:48
You actually brought up an intersting subject between Lamictal and Keppra. When I tried Lamictal at 150mg (15 days) I felt a little social anxiety relief but felt dead energy wise, maybe because of the Keppra in addition to.
Trying to up the Lamictal and drop the Keppra may be a good option to try. A lot of people can handle two mood stabilizers but I'm more on the depressive side mixed with anxiety and I think having the Keppra on board has made my attempts to increase the Lamictal harder because of feeling to washed out. I think the Lamictal plus Cymbalta will be my next attempt.
My pdoc prescribed the Keppra for anxiety, Lamictal for depression and she has a hard time listening to me because in her head this combo ought to be the magic bullet for me, and I really think she's having a hard time accepting this combo is not working for me.
For anxiety I've also tried Neurontin but it seems to work for 2-3 days then poop out and it never seems to end with dose increase and also made me feel a little paranoid and dumb, along with Topomax. I was actually scared to deal with anything while on these meds. I also experienced flatulance problems with both of these, ever heard of that?
Posted by boomarang on September 19, 2004, at 13:56:18
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by theo on September 19, 2004, at 10:21:30
i'm taking the lamictal and cymbalta combo you are considering. per your comment, since starting the combo i've noticed an increase in air on my stomach too. check out my lamictal with cymbalta journal on this board.
Posted by karaS on September 19, 2004, at 15:14:58
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by theo on September 19, 2004, at 7:58:15
I just wanted to mention that several people who are taking Cymbalta now have reported an increase in motivation. That is one of the reasons I am considering trying it soon.
Posted by SLS on September 20, 2004, at 7:32:56
In reply to Dr. Ivan Goldberg » SLS, posted by iris2 on September 19, 2004, at 10:06:57
Hi Irene.
> I saw you mentioned this doctors name. I had called his office for an appointment once and left a message. I have had difficulty finding a new pdoc in Pittsburgh. What do you think of going to him as my pdoc? I have not inquired as to the cost yet. Do you have any idea?
I can't remember exactly how much he charges for an initial visit or consultation, but I know it is at least $500. He is particularly interested in treatment-resistant bipolar disorder. I really can't comment on the quality of his administration since I have never seen him. He seems to be a very compassionate man.
Isn't Western Psychiatric (University of Pittsburg) out there? I can't imagine that you couldn't at least get a referral from them. Dr. Kupfer is one of the best out there.
- Scott
Posted by SLS on September 20, 2004, at 9:44:43
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 19, 2004, at 7:11:03
9/20/2004
Day 32
6 days at 30mg
26 days at 60mg60mg (30mg b.i.d.)
Efficacy :-)
Side effects :-)
- Scott
Posted by iris2 on September 20, 2004, at 12:46:50
In reply to Re: Dr. Ivan Goldberg » iris2, posted by SLS on September 20, 2004, at 7:32:56
> Isn't Western Psychiatric (University of Pittsburg) out there? I can't imagine that you couldn't at least get a referral from them. Dr. Kupfer is one of the best out there.
>
>
> - ScottThanks Scott,
I think I tried his office at least once. I tried Dr. Thases office and spoke with him myself several times but he was either not interested or not taking new patients. It is a little difficult because the pdoc I have now used to be in charge of the entire depression part of that hospital and knows these doctors. I know he is not found of Dr. Kupfer and that his daughter goes to Dr. Thase. I guess I could try again as it has been a couple years. There is one other doctor here that I have interacted with that I think would work well with my needs. He is trying to retire. He had reffered me to a couple of names and offered to advise those doctors for me but neither of them felt comfortable seeing me. I have gone through or been reffered to many doctors at W.P.I.C. to call over the last couple of years and they do not pan out for one reason or another. Usually either they are not taking new patients or most of the time say they are not qualified to treat me.
Thanks for bringing it up again. I guess I could try those three doctors one more time. It is most likely a dead end for me though.
AndrewB suggested reading Dr. Jay Goldstiens books and trying to find a doctor that practices in a similar vein. I am not sure how to find such a doctor? I will look up his name agian on the net and see what I find. I also think his books are going to be over my head.
irene
Posted by boomarang on September 20, 2004, at 14:06:30
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 20, 2004, at 9:44:43
i am so happy for you scott!
Posted by Rayray on September 20, 2004, at 18:04:39
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 20, 2004, at 9:44:43
Yiiipppiiiieeeeeee, Scott! I'm glad Cymbalta is finally taking hold for you. I'm seeing my pdoc this Saturday and hope to get on the bandwagon, too.
A great big thanks to you and everyone else who is keeping a journal and sharing it. It is truly a great service to "our" community.
Any thoughts on a comparison of Cymbalta with Zoloft? That (150mg) and Wellbutrin (300 mg.)is what I'll be switching from.
Hip! Hip! Hoooo----
Ray
Posted by Nohope on September 21, 2004, at 2:47:18
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 20, 2004, at 9:44:43
That's great! Fingers crossed for continued (and continuous) improvement.
Posted by quarterwit on September 21, 2004, at 7:32:04
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 20, 2004, at 9:44:43
Scott, this is great -- didn't you have a bad spell when you didn't think it would work -- after an initial POSITIVE response?
Cymbalta's next up for me. It looks like I'll be weaning the Parnate. I'm one of the few where side effects were severe on this med, with no way to mitigate them without blood pressure problems. I had blood pressure probs to begin with though, so that may play a role in Parnate's intolerability and ultra-sensitive reactivity.
In a rare show of enthusiasm for something new -- rather than impatience with me! -- my doc is hopeful about the eventual transdermal Selegiline. But who knows when that will be out.
Weaning the Parnate shouldn't be that tough -- I could only stay on >20 mg doses for several weeks. Then on to Cymbalta.
Good to hear you're better --
> 9/20/2004
>
> Day 32
>
> 6 days at 30mg
> 26 days at 60mg
>
> 60mg (30mg b.i.d.)
>
> Efficacy :-)
>
> Side effects :-)
>
>
> - Scott
Posted by SLS on September 21, 2004, at 7:39:17
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by quarterwit on September 21, 2004, at 7:32:04
> Scott, this is great -- didn't you have a bad spell when you didn't think it would work -- after an initial POSITIVE response?
Yes.
I experienced a significant antidepressant response on my 12th day of treatment. It lasted for about 3 days and then disappeared. This has been the pattern of drug failure for me. I really had no reason to believe that an improvement would reappear - only hope.
I'm not out of the woods yet. It is still so early in treatment. I can't help but to be optimistic though.
This is what I'm taking:
Cymbalta 60mg
Lamictal 150mg
Namenda 20mg
Abilify 10mgBecause I am bipolar, it is possible that I need one or more of these other drugs for the Cymbalta to be effective.
- Scott
Posted by michael on September 21, 2004, at 11:56:54
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by quarterwit on September 21, 2004, at 7:32:04
> ...In a rare show of enthusiasm for something new -- rather than impatience with me! -- my doc is hopeful about the eventual transdermal Selegiline. But who knows when that will be out...
Hi -Sorry for the quick hi-jack here, but I just have to ask... You said your doc mentioned transdermal selegiline - did he happen to mention if he had any idea when it would be available?
(I know it sounds like he didn't, but had to ask.)Thanks,
michael
Posted by Pristine on September 22, 2004, at 12:55:16
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 20, 2004, at 9:44:43
>Scott,
You seem to be the only one that has been on Cymbalta for 32 days. I was on Cymbalta for 17 days at 60mg once a day. My wife said I was out of it and was not functioning well. There did seem to be something positive going on in a way. I stopped it on day 17 it has been 5 days without it and maybe I should give it a try again at perhaps a different dosage. Is 17 days too early to tell if it will work? When was it that you really knew it was doing well for you? Any insights would be appreciated. Thank you so much for your help.
9/20/2004
>
> Day 32
>
> 6 days at 30mg
> 26 days at 60mg
>
> 60mg (30mg b.i.d.)
>
> Efficacy :-)
>
> Side effects :-)
>
>
> - Scott
Posted by Paul_d_234 on September 22, 2004, at 14:08:42
In reply to Re: Cymbalta (duloxetine) - report, posted by Pristine on September 22, 2004, at 12:55:16
Up to 2 months at right dose.
Side effects are generally heavier the first 4 weeks and then sometimes begin to fade, while benefits generally do not start for up to 4-8 weeks.
Some folks see benefits sooner but don't bank on it.
Posted by Jasmineneroli on September 22, 2004, at 16:38:58
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 21, 2004, at 7:39:17
Hi Scott:
I've been watching your progress (and I think it seems like *progress* now :)!) with Cymbalta. I just wanted to thank you very much for taking the time to share your experiences frequently. It helps everyone a lot, to follow along with someone's " trial & error" process on a given drug or combo therapy. Even if they are not taking, or contemplating taking, the same drug(s) themselves. Because so many of us have to try loads of drugs/therapies and experiment constantly on oursleves.....it's really good to know others are in the same boat.
I appreciate all your responses to other posters/threads too. They're always so well written and thoughtful. I think it must take quite an effort some days, having read about your situation! You are obviously a caring person.
Keep it up, Psycho-Babble is a better place with you here :).
Regards,
Jas
P.S. I have started a new thread re: Wellbutrin augmentation, and would appreciate your input. Thx
Posted by quarterwit on September 22, 2004, at 16:45:07
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 21, 2004, at 7:39:17
BTW, was Parnate your last AD before Cymbalta? If so, how long did you wait after flushing Parnate to start the new one? I know the guideline is 2 weeks, as always. Thanks
> > Scott, this is great -- didn't you have a bad spell when you didn't think it would work -- after an initial POSITIVE response?
>
> Yes.
>
> I experienced a significant antidepressant response on my 12th day of treatment. It lasted for about 3 days and then disappeared. This has been the pattern of drug failure for me. I really had no reason to believe that an improvement would reappear - only hope.
>
> I'm not out of the woods yet. It is still so early in treatment. I can't help but to be optimistic though.
>
> This is what I'm taking:
>
> Cymbalta 60mg
> Lamictal 150mg
> Namenda 20mg
> Abilify 10mg
>
> Because I am bipolar, it is possible that I need one or more of these other drugs for the Cymbalta to be effective.
>
>
> - Scott
>
>
Posted by jerrympls on September 22, 2004, at 17:43:21
In reply to Re: Dr. Ivan Goldberg » iris2, posted by SLS on September 20, 2004, at 7:32:56
> Hi Irene.
>
> > I saw you mentioned this doctors name. I had called his office for an appointment once and left a message. I have had difficulty finding a new pdoc in Pittsburgh. What do you think of going to him as my pdoc? I have not inquired as to the cost yet. Do you have any idea?
>
> I can't remember exactly how much he charges for an initial visit or consultation, but I know it is at least $500. He is particularly interested in treatment-resistant bipolar disorder. I really can't comment on the quality of his administration since I have never seen him. He seems to be a very compassionate man.
>
> Isn't Western Psychiatric (University of Pittsburg) out there? I can't imagine that you couldn't at least get a referral from them. Dr. Kupfer is one of the best out there.
>
>
> - ScottI've emailed Dr. Goldberg many times and he has always replied. He's a very compassionate man and is very committed to his work and to helping people. However, I don't know anyting about how much it costs to get an appointment with him.
Jerry
Posted by theo on September 22, 2004, at 18:02:39
In reply to Re: Cymbalta (duloxetine) - report, posted by Pristine on September 22, 2004, at 12:55:16
After stopping Cymbalta did you have any discontinuation side effects?
Posted by SLS on September 22, 2004, at 18:04:29
In reply to Re: Cymbalta (duloxetine) - report, posted by quarterwit on September 22, 2004, at 16:45:07
Hi.
> BTW, was Parnate your last AD before Cymbalta? If so, how long did you wait after flushing Parnate to start the new one? I know the guideline is 2 weeks, as always. Thanks
The last antidepressant that I was taking before Cymbalta was imipramine. I pretty much crossed-over immediately. I'm sure you know that the traditional waiting period between discontinuing an MAOI and beginning a SRI (serotonin reuptake inhibitor) drug like Cymbalta is two weeks. It takes time for the body to manufacture enough MAO enzymes to replace what has been irreversibly disabled by Parnate. I have heard of some doctors allowing their patients to begin a new drug after waiting only 7-10 days from the last dose of an MAOI. I personally have alway respected the two week recommendation. I guess I'm just a prude.
- Scott
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